In this MD Newsline exclusive interview with endocrinologist/obesity medicine specialist Dr. Rocio Salas-Whalen, we discuss how to provide culturally sensitive care for patients with severe obesity.
How has your cultural knowledge helped you to better treat obesity and reduce the burden of disease on your patients?
Dr. Rocio Salas-Whalen:
“I’m from Mexico, and it’s a very pro-food culture, with food being a very social thing. If you go to a Mexican home and they offer you food, and you refuse it, it’s almost offensive. Right? So you feel like you have to eat it. Or you’re told, ‘finish your whole plate because there’s other people who don’t have food. Eat, eat, eat.’
I am aware of those cultural experiences, and I can talk with my patients about what to do when they’re confronted in those situations by social pressure and familial pressure. So I prepare them, so they don’t succumb to the pressure to eat more, and I prepare them to discuss their obesity treatment with their loved ones because the thinking around food has to change.
I think having this cultural knowledge helps me to be less politically correct and more straightforward and comfortable with my patients when having these conversations, with the aim of improving my patients’ quality of life.”
How do you equip your patients to confront cultural and familial pressures to eat more?
Dr. Rocio Salas-Whalen:
“It’s a behavioral approach. First, my patients will be pressured to eat more. For my patients who are on weight-loss medication, the whole purpose of the medication is it controls how much you eat by increasing satiety, so you cannot finish a whole plate.
So I give them the tools to not succumb to the pressure. So I teach them to say, ‘no, I’m completely full. I’m satisfied. I can try something later.’
Another thing that is very cultural is, if you’re a healthy-weight person in a family whose members are primarily overweight or have obesity, you’re told, ‘are you sick? What’s happening? Are you sick? I don’t think that’s normal.’ And all of those comments impact the patient significantly who feels like, ‘oh no, now everybody’s telling me I look different.’
So I do have to have those talks with my patients to prepare them to stay motivated at that point. I don’t tell them to say, ‘no, everybody else is unhealthy. I’m the healthy one.’ Many patients on their own have that discussion with their family members, which is nice.”
Responses have been condensed and lightly edited.